CDPH Gateway/CAIR2 – 5 Steps to Data Exchange

Provider sites who are interested in submitting immunization data to CAIR2 from their EHR systems should following the 5 steps listed below unless they are in Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, or Tuolumne counties, inc which case they should contact CAIR San Joaquin or in San Diego county, in which case they should contact CAIR San Diego for assistance. Note: Patient disclosure is required before immunization data can be entered into or submitted to CAIR. For more information, please refer to the CAIR Disclosure/Sharing Policy page.

For an official letter stating when CAIR (7 regions only) became able to receive ‘meaningful use’-qualifying immunization data, click here.

Below are the 5 Steps your Site will need to complete in order to submit electronic data to CAIR2:

Retain this CDPH HIE Gateway/IZ Portal registration confirmation email for future reference. Note: These secure emails will contain Site credentials as well as information on the follow-up steps your Site must take to prepare for data exchange with CAIR2.

Step 3 – Initial Test Submission (Site Types #1 and #3)

The new CAIR2 database is in a different location. Submitters will need to download and install the CAIR2 TEST WSDL (URL: https://cair.cdph.ca.gov/CATRN-WS/IISService?WSDL) to the server/interface engine that will be submitting the HL7 messages.

Test messages should be submitted at least a month before the end of the 90-day attestation reporting period, to allow time to address any unforeseen problems.

Submitted test messages will be validated against the CAIR2 HL7 specification

As each submitted HL7 VXU message is received by CAIR2, an HL7 ACK (message accepted) or NAK (message has errors/warnings) is returned back to the submitter.

The returned ACK/NAKs will help to guide your Site in making changes to your data formatting until you can submit a message without errors. These ACK/NAKs follow the format laid out in the CDC HL7 Version 2.5.1: Implementation Guide for Immunization Messaging, Release 1.5 and will provide details as to any segments/fields that contain errors. The NAK will also inform as to whether the error constituted a message failure or simply an informational error/warning.

If your Site is submitting data to CAIR2 through an intermediary Sending Facility, you should contact the Sending Facility/EHR vendor to determine whether ACK/NAKs returned to the Sending Facility by CAIR2 can be returned and displayed in your EHR.

Sites must monitor returned ACK/NAK messages and make corrections to their submissions as needed. Test messaging will also be monitored by DX staff.

If your Sending Facility is unable to return ACK/NAKs or your EHR system is unable to display them, your Site will still be able to monitor data exchange messaging via the ‘Check Status’ functionality in the CAIR2 interface that is available to CAIR2 ‘Power’ users or the ‘Data Exchange Quality Assurance’ (DX QA) user role. Go to the CAIR2 Account Update site to add a ‘Power’ user (requires formal training) or DX QA user (does not require training).

Send a new set of test messages to CAIR2 for validation of ongoing data submissions

A minimum of 50-100 unique test messages bshould be submitted to CAIR2 using a variety of coded values in the HL7 VXU messages.

Test messages will be validated against the CAIR2 HL7 specifications and any errors found will be returned to the Site in an ACK/NAK for review.

Address any errors found

If there are any errors occurring that require further discussion, a CAIR Data Exchange Specialist (DXS) is available to assist at CAIRDataExchange@cdph.ca.gov; include your assigned CAIR2 ID and your CAIR2 Sending Facility ID (if you have one) in the email.

Move to ‘Pre-Production’

After a minimum of 50 test messages have been validated and found to contain zero errors, CAIR asks that the Site send production data from their EHR to CAIR2 production (in a ‘testing’ state) to ensure data quality.

During ‘pre-production’, CAIR2 will monitor production data until it is determined that the data quality is found to be satisfactory.

Any errors found during this process should be addressed by the Site and data resubmitted.

Move to ‘Production’

Once it has been determined by the CAIR2 DX Staff that a Site’s data has passed pre-production validation, the site is then moved from a ‘testing’ state to ‘production’.

Site Type #2: Indirect

Your intermediary Sending Facility should notify you when your site has moved to production

Step 5 – Ongoing Submission of Patient Data

Using bidirectional messaging, your EHR system may be able to retrieve and display patient immunization histories and doses due recommendations from CAIR2. BiDX will also be a MU Stage 3 requirement in 2019 and CAIR2 has begun onboarding sites to BiDX . Follow the steps below to prepare for BiDX.

Consult with your vendor support as to the bidirectional readiness of your current EHR and whether there may be additional costs/EHR upgrades necessary for BiDX.

In order to receive accurate patient recommendations from CAIR2, CAIR2 needs to have full active patient histories. Consider submitting all active patient historical doses to CAIR2. Consult with one of our CAIR Data Exchange Specialist about submitting prior immunizations records (historical data) for your active patients.